London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, UK.
Instituto de Saúde Coletiva. Rua Basílio da Gama, s/n. Canela. CEP 40110040. Salvador, Bahia, Brasil.
Trans R Soc Trop Med Hyg. 2018 Jul 1;112(7):301-316. doi: 10.1093/trstmh/try063.
Chikungunya is a mosquito-borne disease caused by an arthritogenic alphavirus, with four genotypes: East Central South African (ECSA), West African, ECSA-diverged or Indian Ocean Lineage (IOL) and Asian lineage. Overall, the disease is self-limited; however, in some patients, joint pain and other non-specific symptoms can last for months or years. This systematic review and meta-analysis aims to estimate the proportion of people that self-report chikungunya-related chronic non-specific symptoms.
Medline, EMBASE, Global Health Library and Scopus were searched for articles published before March 2017. Case-control, cohort, cross-sectional, clinical trials studies and outcome-independent case series were eligible. It was estimated that the proportion of patients who did not recover, by virus genotype, and by the time between disease onset and assessment of chronic symptoms.
A total of 38 studies were included in the review and 34 in the meta-analysis. Of 6532 chikungunya patients, 3157 did not recover fully after 3 months. The overall no recovery rate associated with chikungunya was 43% (95% CI, 35-52%); Inter-genotype group heterogeneity was observed, the highest prevalence in the ECSA-diverged genotype: 50% (95% CI; 40-60%), followed by the Asian lineage genotype: 36% (95% CI; 20-52%). After 12 months follow-up, the overall no-recovery rate was 21% (95% CI; 19-22%).
The evidence suggests that the prevalence of chronic discomfort associated with chikungunya illness varies by virus lineage. The proportion of people that do not fully recovered after chikungunya was high and, therefore, health authorities must prepare to treat patients with symptoms of long-lasting chikungunya adequately addressing the physical, psychological and social needs.
基孔肯雅热是一种由节肢动物传播的疾病，由致关节炎的阿尔法病毒引起，有四个基因型：东中非南非型（ECSA）、西非型、ECSA 分化型或印度洋谱系（IOL）和亚洲谱系。总的来说，这种疾病是自限性的；然而，在一些患者中，关节疼痛和其他非特异性症状可能会持续数月或数年。本系统评价和荟萃分析旨在估计报告与基孔肯雅热相关的慢性非特异性症状的患者比例。
检索了 Medline、EMBASE、全球卫生图书馆和 Scopus 数据库，检索时间截至 2017 年 3 月之前发表的文章。病例对照、队列、横断面、临床试验和无结局依赖病例系列研究均符合纳入标准。根据病毒基因型和疾病发病至评估慢性症状之间的时间，估计未恢复的患者比例。
共纳入 38 项研究，其中 34 项进行了荟萃分析。在 6532 例基孔肯雅热患者中，有 3157 例在 3 个月后未完全恢复。基孔肯雅热相关未完全恢复的总体发生率为 43%（95%CI，35-52%）；存在基因型间组内异质性，ECSA 分化型的发病率最高：50%（95%CI，40-60%），其次是亚洲谱系基因型：36%（95%CI，20-52%）。12 个月随访后，总体未恢复率为 21%（95%CI，19-22%）。
证据表明，与基孔肯雅热相关的慢性不适的流行率因病毒谱系而异。基孔肯雅热后未完全恢复的人群比例较高，因此卫生当局必须准备充分治疗有长期基孔肯雅热症状的患者，充分满足其身体、心理和社会需求。
